There’s nothing rational about rationing health care services 

Thinking of Donald Berwick made me think of Jacques Barzun. Berwick is the Harvard professor that President Barack Obama snuck into the job of Medicare and Medicaid chief. Barzun is a magnificent intellectual.

What gives, then? Let me start with Barzun’s “From Dawn to Decadence.” Barzun, born in France but an American for a long time, shows in this work how the West has gradually lost some of its sense of direction. A “mongrel civilization par excellence,” the West has borrowed from all over the place and is as diverse as it gets, Barzun says, adding that it has shown unity in some remarkable ideas and institutions that are not to be discovered anywhere else.

One of those ideas — now in jeopardy — is individualism. A major modern threat to it is the welfare state, which assumes “everyone should be safe and at ease in a hundred different ways.” This political invention is enormously wasteful and usually corrupt. Though we are still left with plenty of poverty, Barzun says, the cost of the welfare state is enormous and the resounding complaint is “not enough.”

Enter Berwick, who will be a key player in fashioning the details of the Obama health care remake. He got his job through a recess appointment while Congress was out of town and therefore hasn’t had to answer tough questions publicly. But we know where he’s coming from.

To be “humane,” he has said, any health care plan “must redistribute wealth from the richer among us to the poorer.” Any system driven by the market is “unaccountable.”

It’s worth taking a look at this rational rationing. A government agency calculates whether a given treatment is worth what it would cost to improve health or help someone live longer, then it can make people wait so long for treatment that they die first. Many victims are the elderly.

Next time you hear younger people wondering about the wisdom of treating those getting on in years, ask them whether a great book counts as a great social contribution. When they give you a blank look, tell them there’s this American with a French name who was born in 1907, is still around and wrote an absolutely fantastic book about a civilization that’s lately been at odds with some of its best ideas. And, inform them he was 93 when he finished.

Examiner columnist Jay Ambrose is a former Washington opinion writer and editor of two dailies. He can be reached at

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